PESCI Preparation Guide for IMGs in Australia

For International Medical Graduates (IMGs) aspiring to practise medicine in Australia, the Pre-employment Structured Clinical Interview (PESCI) is a key step on the registration pathway. Thoughtful PESCI preparation can make the difference between a smooth application process and a frustrating delay.

This guide explains what the PESCI is, who needs it, how it is structured and scored, and how IMGs can approach PESCI preparation in a systematic, confident way.

The PESCI is administered by three accredited providers:

• Australian College of Rural and Remote Medicine (ACRRM)

• Royal Australian College of General Practitioners (RACGP)

• Institute of Medical Education (METC Institute)

All three are accredited by the Australian Medical Council (AMC), but their formats and support resources differ, so informed choice and targeted PESCI preparation are important.

Many PESCI assessors emphasise that the interview is not a trivia test: “We want to see that you think clearly, practise safely, and can work in this specific role.”

Purpose Of The PESCI

The PESCI is a safety check. It confirms that IMGs have the knowledge, skills, clinical experience, and personal attributes needed to provide safe and effective care in Australian general practice.

The assessment:

• Focuses on patient safety and the quality of care.

• Is overseen by the AMC, which sets standards across all providers.

• Allows providers some flexibility, so the interview style, scenarios, and emphasis may vary slightly.

A key point for PESCI preparation is that the assessment is position-specific. The interview assesses your suitability for a particular job in a specific practice and context. A successful PESCI for one job usually cannot be transferred to a different role. That means:

• You may need to sit another PESCI if you change employers or locations.

• Your PESCI preparation should be closely matched to the job description, level of supervision, patient mix, and practice setting (urban, regional, or rural).

The PESCI is not a written test of theory. It asks whether you “know how” to apply your knowledge in realistic consultations. Expect to be judged on:

• How you reason through a case.

• How you speak with patients.

• How you handle uncertainty.

• How you work within Australian guidelines and systems.

Who Needs A PESCI?

Most IMGs on the Competent Authority or Standard pathway who are seeking provisional or limited registration to work in general practice in Australia will require a PESCI.

Typically, a PESCI is required when:

• You are an IMG on the Competent Authority or Standard pathway.

• You are applying for provisional or limited registration in general practice.

• You have a specific job offer that involves independent or semi-independent clinical work.

Common exemptions include:

• Specialist IMGs applying through the Specialist or Expedited Specialist pathway, whose qualifications are assessed by the relevant specialist college rather than by PESCI.

• Some positions with very close supervision or minimal clinical risk (assessed case by case by the Medical Board).

For IMGs applying for limited registration in an area of need in general practice:

• You must usually have at least three years full-time equivalent (FTE) experience in general practice or primary care.

• Ahpra advises these applicants to apply for registration first.

• The Medical Board will assess your experience, and if it is sufficient, a PESCI will then be arranged.

• The Board decides whether a PESCI is needed, taking into account the role’s risk and context.

For IMGs on the Competent Authority pathway, a PESCI is often required for general practice roles instead of the AMC Clinical Exam. This makes PESCI preparation a central part of your registration plan.

Because requirements vary by pathway and role, IMGs should:

• Check the Medical Board of Australia and Ahpra websites early.

• Confirm whether a PESCI is required for their intended job and registration type.

• Plan PESCI preparation timelines around registration deadlines and job start dates.

Eligibility For The PESCI

To be eligible for a PESCI, most candidates must:

• Have passed the AMC CAT MCQ examination or qualify for the Competent Authority pathway.

• Hold a primary medical qualification listed in the World Directory of Medical Schools (WDOMS).

• Have a valid job offer in Australian general practice.

• Meet the Medical Board of Australia’s overarching registration requirements.

Some providers have their own eligibility tools. For example:

• ACRRM offers a PESCI eligibility checklist on its website to help you confirm that you meet their criteria.

These requirements reflect the intended progression:

1. Demonstrate a basic level of medical knowledge (AMC MCQ or Competent Authority).

2. Obtain a suitable job offer.

3. Undergo a PESCI that tests whether you are fit for the specific role.

As you plan PESCI preparation, you should review:

• The scope of the job (procedures, on-call, after-hours).

• The level of supervision and available support.

• The patient population (age mix, cultural groups, chronic disease burden).

Aligning your PESCI preparation with the realities of your role helps you answer questions in a way that matches the practice’s expectations.

Structure Of The PESCI

The PESCI is a structured clinical interview built around case-based scenarios. While details vary slightly by provider, there are common features.

Typical structure:

• Conducted by a panel of at least three members:

  • Usually experienced GPs.

  • Often includes a community member or another health professional.

• Delivered in person or online (many now use videoconference platforms such as Zoom).

• Built around multiple clinical scenarios. For example, RACGP usually uses five scenarios.

For each scenario you will usually:

1. Receive brief reading time to review the case.

2. Answer structured questions about:

   • History taking.

   • Relevant examination (described verbally).

   • Differential diagnoses and reasoning.

   • Investigations.

   • Management plan and safety netting.

3. Demonstrate communication skills and professionalism throughout.

Assessors typically rate you across domains such as:

• Medical interviewing and history taking.

• Physical examination (theoretical description).

• Clinical reasoning and judgment.

• Management, prescribing, and advice.

• Communication skills.

• Professionalism and ethical practice.

• Procedural skills (if relevant to the job).

RACGP and ACRRM have detailed handbooks that describe the format and domains in depth, and reading them is an important early step in PESCI preparation.

The structured nature of the interview means that success depends not only on knowledge but also on your frameworks and habits: how you open a consultation, how you structure answers, and how you work within the time limit.

Core PESCI Assessment Domains And Competencies

Although providers describe domains slightly differently, most PESCIs focus on a common set of competencies. Understanding these helps you direct your PESCI preparation.

Key domains include:

Clinical Knowledge And Skills

• Taking a thorough, focused history.

• Describing a logical, targeted examination.

• Formulating reasonable differential diagnoses, prioritising serious conditions.

• Outlining safe and evidence-based investigation and management plans.

• Applying Australian guidelines, referral pathways, and local public health programs.

Communication Skills

• Building rapport from the start of the consultation.

• Explaining diagnoses and management plans in plain language.

• Checking understanding (for example, using “teach-back”).

• Involving patients in shared decision-making.

• Communicating respectfully with colleagues and other health professionals.

Professionalism, Ethics, And Clinical Governance

• Respecting confidentiality and privacy, and understanding their limits.

• Obtaining informed consent.

• Maintaining professional boundaries.

• Handling complaints, disagreements, or errors.

• Knowing your limits and when to seek senior advice or refer.

Australian Healthcare Context

• Working within the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS).

• Understanding typical referral pathways to public and private services.

• Knowing national screening and immunisation programs.

• Being aware of practice accreditation, incident reporting, and quality improvement activities.

Cultural Safety And Patient-Centred Care

• Adapting communication for patients from different cultural and linguistic backgrounds.

• Demonstrating respect and understanding when caring for Aboriginal and Torres Strait Islander patients.

• Recognising social determinants of health and their impact on care.

• Involving family and carers where appropriate.

High-quality PESCI preparation should cover all of these domains, not just clinical facts. Practising scenarios that explicitly test communication, ethics, cultural safety, and clinical governance is essential.

A helpful mindset is: “If I make my clinical reasoning clear and keep safety first, the panel can see how I practise, even when I am unsure about every detail.”

Key Clinical Topics And Scenarios For PESCI Preparation

PESCI scenarios reflect common and important presentations in Australian general practice. You do not need to know every condition in depth, but you must show a safe, structured approach across a broad set of topics.

When planning PESCI preparation, ensure you review:

Foundational Consultation Skills

• Structured history taking:

  • History of presenting complaint.

  • Systems review as appropriate.

  • Gynaecological, paediatric, and geriatric histories.

  • Brief psychosocial history (mental health, substance use, supports).

• Describing focused examinations for different systems.

• Creating management plans that include:

  • Investigations.

  • Treatment.

  • Lifestyle advice.

  • Safety netting and follow-up.

Common Clinical Areas

Examples of high-yield areas for PESCI preparation include:

• Cardiology – chest pain, palpitations, syncope, hypertension, dyslipidaemia, heart failure, atrial fibrillation, and acute coronary syndrome in the GP setting.

• Respiratory – asthma, COPD, allergic rhinitis, sleep apnoea, haemoptysis, chronic cough.

• Endocrinology – type 2 diabetes (including insulin use and DKA recognition), thyroid disease, tiredness, obesity.

• Gastroenterology – abdominal pain, diarrhoea, constipation, coeliac disease, diverticulitis, bowel cancer screening.

• Dermatology – common rashes, eczema, psoriasis, acne, benign versus malignant skin lesions (including melanoma).

• Obstetrics And Gynaecology – antenatal and postnatal care, contraception (including emergency contraception and IUDs), abnormal uterine bleeding, menopause, PCOS, early pregnancy bleeding.

• Paediatrics – immunisations, fever, otitis media, croup, asthma, unsettled baby, common behavioural concerns.

• Psychiatry – depression, anxiety, suicidal ideation, substance use, smoking cessation, basic mental state examination.

• Musculoskeletal – back pain, knee and shoulder pain, acute injuries, osteoporosis.

• Infectious Diseases And Sexual Health – UTIs, prostatitis, STIs including HIV, hepatitis, and syphilis, with attention to at-risk populations.

• Geriatrics – falls risk, polypharmacy, cognitive impairment, functional assessment.

You do not need to replicate a full college curriculum in your PESCI preparation, but you should be comfortable with:

• Assessing acuity and ruling out emergencies.

• Explaining long-term management for chronic disease.

• Applying screening and preventive health recommendations.

The PESCI Registration Process

The exact process differs slightly between providers, but the general steps are similar. Early planning is important so that PESCI preparation can run alongside paperwork and verification.

RACGP

For RACGP, the process usually includes:

1. Secure a suitable GP position in Australia.

2. Apply to the AMC for primary source verification of your qualifications.

3. Obtain an RACGP ID to access the online PESCI application.

4. Submit the online application with required documents, such as:

   • Curriculum vitae (CV) using the RACGP template.

   • Name change documentation (if applicable).

   • Evidence of passing the AMC CAT MCQ exam.

   • Proof of current medical registration.

   • Detailed position description on the RACGP template.

   • Ahpra supervised practice plan and supervisor’s agreement (SPPA-30).

   • Signed PESCI applicant declaration.

   • Certified translations of any non-English documents.

5. Pay the interview fee.

ACRRM

For ACRRM:

• Applications are submitted online via the ACRRM website.

• ACRRM has its own documentation checklist and forms.

• PESCIs are usually conducted by video conference, which may influence how you plan your PESCI preparation and practise speaking to camera.

METC Institute

For METC Institute:

• There is an eligibility check, followed by:

  • Purchasing and submitting the online application.

  • An application review by the provider.

  • Scheduling of the interview.

• METC offers both in-person interviews in Queensland and virtual interviews across all states and territories. This flexibility can be a factor in your choice and PESCI preparation strategy.

Across all providers:

• Read the current handbook and policies for your chosen organisation.

• Allow time for:

  • Primary source verification through the AMC’s EPIC system.

  • Application processing and interview scheduling.

• Build your PESCI preparation timetable around confirmed interview dates and expected waiting times.

PESCI Preparation Resources

There is a wide range of resources available to support structured PESCI preparation.

Official College And Regulatory Resources

• RACGP and ACRRM publish:

  • PESCI handbooks.

  • Policy documents.

  • Guidance on domains and interview structure.

• ACRRM provides an online preparation module explaining the process.

• The websites of Ahpra, the AMC, and the Medical Board of Australia outline:

  • Registration standards.

  • Codes of conduct.

  • Expectations around supervision and clinical governance.

Reviewing the RACGP Curriculum for Australian General Practice and national guidelines (for example via the NHMRC) can help anchor your clinical PESCI preparation in the Australian context.

Third-Party PESCI Preparation Providers

Several organisations offer structured PESCI preparation programs, including:

• LearnMedicine – PESCI-focused training, realistic scenarios, and mock interviews (see below).

• IMGSOS – mock interviews and detailed feedback.

• PassGP – scenario-based learning modules and exam-style questions.

• ARIMGSAS – emphasis on communication skills and cultural awareness.

These services can be particularly helpful if:

• You are unfamiliar with Australian general practice.

• English is not your first language.

• You learn best through live discussion and feedback.

LearnMedicine PESCI Preparation

LearnMedicine offers a comprehensive suite of PESCI preparation courses for IMGs.

Key features include:

• Realistic clinical scenarios that mirror PESCI cases across all major systems.

• Structured answer examples showing how to cover history, examination, differential diagnoses, management, safety netting, and follow-up within time limits.

• Mock interviews with experienced medical educators who understand PESCI expectations.

• Personalised feedback that pinpoints knowledge gaps, communication issues, and structural problems in your responses.

• Guidance on:

  • Australian guidelines and referral pathways.

  • Cultural safety and communication with different patient groups.

  • Common pitfalls that lead to borderline or unsatisfactory ratings.

With LearnMedicine, IMGs can carry out PESCI preparation in a systematic way, practising under exam-like conditions and refining both clinical reasoning and consultation style.

Peer Support And Self-Directed Learning

In addition to formal courses, IMGs can build PESCI preparation through:

• Joining online communities and study groups for IMGs.

• Practising cases with peers using marking grids based on PESCI domains.

• Reviewing:

  • The National Immunisation Program.

  • Cancer screening programs.

  • Common Australian guidelines (for example, for diabetes, asthma, and cardiovascular risk).

The more your study materials mirror the PESCI format—case-based, time-limited, and structured—the better your practice will translate into performance.

One IMG who passed on a second attempt summed it up: “Once I practised with real-time feedback and focused on safety first, the interview felt much more like a normal consultation.”

Building An Effective PESCI Preparation Plan

Rather than studying randomly, aim for a structured PESCI preparation plan that builds skills step by step.

Step 1: Understand The Exam And Your Role

• Read your provider’s handbook and your job description.

• Identify:

  • Common conditions in the practice’s population.

  • Level of supervision and support.

  • Procedural expectations (for example, skin excisions, women’s health procedures).

• List the domains and non-clinical skills you must demonstrate.

Step 2: Master Consultation Frameworks

Use consistent structures for most scenarios, for example:

1. Opening – introduce yourself, confirm identity, gain consent, and clarify the patient’s agenda.

2. History – use a logical framework (for example, SOCRATES for pain, or ICE: ideas, concerns, expectations).

3. Red Flags – always ask targeted questions to rule out life-threatening conditions.

4. Examination – describe focused examination steps and what you are looking for.

5. Differentials – list likely and serious diagnoses and explain your reasoning.

6. Investigations – suggest appropriate bedside tests, bloods, and imaging.

7. Management – address:

   • Immediate care.

   • Longer-term treatment.

   • Lifestyle advice.

   • Safety netting and follow-up.

8. Close – check understanding and confirm the plan.

Practise applying this structure across different systems so it becomes automatic during your PESCI.

Step 3: Practise Under Time Pressure

Time management is central to PESCI preparation:

• Use a timer for all practice scenarios.

• Aim to cover:

  • History and red flags.

  • Key examination points.

  • A safe management plan.

  • Safety netting and follow-up.

• Learn to avoid spending too long on minor details at the cost of safety or management.

Step 4: Tackle Different Scenario Types

PESCIs include more than straightforward clinical cases. Build PESCI preparation around:

• Ethical scenarios – confidentiality breaches, consent issues, colleagues practising unsafely, inappropriate requests for certificates.

• Rural or resource-limited scenarios – emergencies far from hospital, limited investigations, transport delays.

• Professionalism scenarios – complaints, communication breakdowns, handover problems.

• Clinical governance scenarios – open disclosure after an error, mandatory reporting, quality improvement.

Role-play these with peers or tutors and always relate your answers back to Medical Board and college expectations.

Step 5: Use Mock Interviews And Feedback

Mock interviews are one of the most powerful PESCI preparation tools:

• Replicate examination conditions as closely as possible.

• Ask assessors to score you against PESCI domains.

• Request detailed feedback on:

  • Clarity and organisation of answers.

  • Coverage of safety and red flags.

  • Communication style and rapport.

  • Use of Australian guidelines.

Use this feedback to create a targeted revision list and repeat mock interviews to track improvement.

PESCI Scoring

Most providers use a numerical scale (often 1–5) for each domain:

• 5 – Highly suitable.

• 4 – More than suitable.

• 3 – Suitable for the position.

• 2 – Borderline or partially suitable.

• 1 – Unsuitable.

Commonly assessed domains include:

• Medical interviewing/history taking.

• Physical examination (theoretical).

• Clinical judgment and reasoning.

• Management and advice.

• Communication.

• Professionalism.

• Procedural skills, if relevant.

After the interview:

• The panel agrees on an overall recommendation about your suitability for the specific position.

• Providers send you a written outcome report, usually within:

  • About 14–15 business days for RACGP and METC Institute.

  • Around 14–21 days for ACRRM.

• A copy of the report goes directly to the Medical Board of Australia for registration decisions.

For PESCI preparation, it is important to understand that:

• A few low scores in key domains can affect the overall recommendation.

• Consistency across domains is often more important than an outstanding performance in one area.

• If you are unsuccessful, the feedback section of the report is a valuable guide for focused PESCI preparation before reapplying.

After The PESCI

Once you pass the PESCI:

• You can proceed with your Ahpra registration application, attaching your PESCI report if required.

• The PESCI outcome is usually valid for 12 months from the date of issue.

• If your job offer falls through or you change practices, you may need:

  • A new PESCI for the new role, or

  • To request a PESCI exemption if the new role is substantially similar (assessed by the Medical Board).

If you are unsuccessful:

• You may reapply for the same or a different position, but each attempt requires payment of the full PESCI fee.

• Providers generally offer options for:

  • Reconsideration.

  • Review.

  • Appeal, under specific conditions and timelines.

These processes:

• Give you a formal way to raise concerns about the conduct of the interview or the decision.

• Often attract additional fees and strict criteria, so they should be used thoughtfully.

If you need to re-sit the PESCI, targeted PESCI preparation based on your feedback report, mock interviews, and coaching support can significantly improve your performance.

Choosing A PESCI Provider

All three providers—RACGP, ACRRM, and METC Institute—are accredited by the AMC, which gives a consistent baseline standard. However, there are differences that may influence your choice and PESCI preparation strategy.

Consider:

• Focus and setting:

  • ACRRM has a strong emphasis on rural and remote medicine.

  • RACGP focuses on general practice across urban, regional, and rural settings.

• Interview modality:

  • ACRRM and METC Institute offer video-conference interviews.

  • METC Institute also provides in-person interviews in Queensland.

• Support resources:

  • Handbooks, example scenarios, and preparation modules differ between providers.

• Historical pass rate trends:

  • There have been reports of varying pass rates (for example, ACRRM sometimes noted as lower than RACGP), but this can change over time. Always seek current, reliable information.

A simple comparison:

Provider Name	Focus / Specialisation	Interview Modality	Key Resources Offered	Website
RACGP	General practice across all settings	Usually online (video conference)	PESCI handbook, templates, curriculum links	RACGP
ACRRM	Rural and remote general practice	Online (video conference)	PESCI handbook, eligibility checklist, module	ACRRM
METC Institute	General practice, multiple locations	In-person (QLD) and online	Preparation guidance and scheduling support	METC Institute

When choosing a provider:

• Check which organisation your employer prefers (some practices have a usual provider).

• Consider whether the provider’s rural focus, interview format, and preparation resources match your needs.

• Factor in logistics (time zones, travel, and internet reliability) when planning PESCI preparation and interview practice.

The PESCI is a significant step for IMGs seeking to practise in Australia. It is designed to confirm that IMGs have the skills and knowledge to provide safe and effective care in the Australian healthcare system. Well-planned PESCI preparation, careful provider selection, and a structured study plan can greatly improve your chances of success.

For IMGs seeking comprehensive PESCI preparation, LearnMedicine offers a range of courses designed to maximise your chances of passing on your first or next attempt. The programs combine realistic scenarios, mock interviews, personalised feedback, and detailed guidance on Australian practice so that you can approach your PESCI with confidence and clarity.